Millions of healthy women undergo routine pelvic exams every year, but on Tuesday a panel of physicians and other medical experts cast doubt on this longstanding pillar of women’s preventive health care.

But that’s NOT what the task force actually advised. The USPSTF advised discontinuing SCREENING BIMANUAL EXAMS, not pelvic exams.

The mainstream media has reported the story inaccurately and women may die as a result.

In order to understand the recommendations, you need to understand what a pelvic exam is.

A pelvic exam contains TWO parts, the speculum exam and the bimanual exam.

The speculum exam involves inserting a metal or plastic speculum in the vagina to push back the vaginal walls and allow the cervix (which is at the end of the vagina) to be seen. The provider can then perform a Pap smear, scraping off cells for examination under the microscope in order to detect cancer and precancerous lesions.

The bimanual (two hands) exam is performed after the speculum exam. Two fingers of the provider’s dominant hand are inserted into the vagina and the other hand is placed on the lower abdomen. The fingers and hand are brought together to feel the uterus, cervix and ovaries between them.

Routine speculum exams are STILL recommended.

Bimanual exams are STILL recommended for any woman with a complaint of pain, vaginal discharge and a variety of other symptoms.

The ONLY thing that the USPSTF recommends discontinuing is SCREENING bimanual exams (when a woman has no GYN symptoms of any kind) to detect POTENTIAL problems. The bimanual exam is a poor screening test because it has a high false positive rate leading to unnecessary ultrasounds and other tests.

No one should think that this means women should avoid the gynecologists or forego speculum exams and Pap smears. The HPV vaccine may ultimately render them unnecessary by preventing cervical cancer and precancerous lesions, but that hasn’t happened yet.

Its conclusion applies only to women who are not pregnant and who do not have pelvic symptoms, such as pain or unusual bleeding. It gave the pelvic exam a grade of “I,” for “indeterminate,” meaning “we don’t have enough evidence to determine the benefits and harms,” said task force member Dr. Maureen Phipps, professor of obstetrics and gynecology at the Warren Alpert Medical School of Brown University and chief of OB-GYN at Women & Infants Hospital of Rhode Island…

The recommendation is unrelated to screening for cervical cancer, which the task force highly recommends. But that can be done without a pelvic exam, an internal and external inspection by sight and touch.

But even then it doesn’t get the terminology correct.

The last line particularly egregious:

ACOG said its current position is not dictated by financial considerations. But if women opt out of pelvic exams, many might visit a gynecologist less often. And if gynecologists do not bill for a pelvic exam and the follow-up it often triggers, their incomes would decline.

But the genesis of the routine pelvic exam is not in obstetrics but in public health. Many routine screening tests (like mammograms) were recommended by public health officials because cancer was imagined to be like infectious disease: early diagnosis would be much more likely to lead to a cure. But cancer is not like infectious disease in that it can spread and become incurable long before the patient has any symptoms. Everyone who has metastatic cancer at one point had a tiny early cancer, BUT not everyone who has an early small cancer will ultimately develop metastatic cancer. The cancer may grow so slowly that the patient dies of another cause first or the body’s immune defenses recognize the tiny cancer and remove it.

Routine bimanual exams were never a plot to make money. They were thought to be the only way to detect early ovarian cancer. Early ovarian cancer is potentially curable and advanced ovarian cancer is almost never curable. Moreover, early ovarian cancer almost never causes symptoms and symptomatic ovarian cancer is almost always deadly. It seemed to make sense to perform routine bimanual exams. Experience has shown us that sadly it doesn’t work. In other words, since bimanual exams can’t diagnose early ovarian cancer, there’s no reason to perform them as a screening test.

Birth control pills reduce the risk of breast cancer. So by denying the pill to women who refuse the pap test, doctors are making it more likely for them to get another form of cancer. The pap test gets customers in the door annually though. Like so much else with women’s health, it’s greed wrapped up in paternalism. If that’s the right word, considering most of the doctors/midwives involved are women.

Azuran

Well, getting a script for the pills require a visit every 1-2 years depending the the place. It’s not greed, it’s proper medical practice.
But the mandatory pap smear is kinda weird. It was totally optional where I got my pills. And unless contraception makes cervical cancer more aggressive, I see no reason why it should be mandatory.

Adelaide

I know this may be a touchy issue, but I’d love a few opinions…..
What about pap smears for women who have no chance of contracting HPV? The obvious example here is a women with no previous sexual contact. The other group would be women with no sexual contact before a monogamous relationship with man with no prior sexual contact.

I get that people lie about their history and so the recommendation is always going to be get a pap smear, but the reality is, is that a women knows if she is lying.

Assuming that a women actually meets one of the above criteria does she need a Pap? Is she being foolish to refuse one?

momofone

I’m not qualified to address your overall question, but I would say that even though a woman can know if she is lying, she may have no idea whether her partner is. That is a devastating way to find out about cheating and/or a sexually transmitted illness.

Adelaide

Obviously a partner could be untruthful about their history or current activities, but for the case of a non-smoking virgin with zero sexual contact there are a lot of providers still insisting on a PAP. Is there a reason?

Before I was married I was belittled, screamed at, and once locked in a room and threatened (all by three different providers) because I was a virgin with zero sexual contact and refused a pap smear. None of them could tell me my risks or give me anything close to informed consent. I understand the recommendation, but I don’t understand the resistance when a virgin knowledgably refuses the test.

To ask a prudish women with an intact hymen who has never had anyone as much as look at her below the belt to strip and allow a stranger to insert a speculum is extremely invasive.

Am I missing something?

fiftyfifty1

“Am I missing something?”

Yes. Being locked in a room and threatened is not medical practice, it’s kidnapping. I urge you to press charges and report this provider to the state board.

Adelaide

It was years ago and all the appropriate paperwork was filed, complaints made, etc etc. I wish more had come of it, but at least I got out (thanks to a lot of screaming for help) without any more harm, although I still refuse to see male doctors in anything but life threatening circumstance.

The few other women I know who have faced this, particularly the ones wanting birth control before their wedding without any type of pap or vaginal exam have faced some pretty ugly responses from providers. I’ve never quite understood the vehemence of so many medical professionals on this issue.

I went with a friend to the OB when she wanted birth control 3 months before her wedding. Despite her explanation that she had no previous sexual contact the sympathetic OB refused her without a PAP due to policy. To add insult to injury though the nurse came in and told her she should be using condoms with her soon to be husband all the time because there was no way he was a virgin. When I told her that was inappropriate she screamed at us both about using condoms and STDs until half the office was in there trying to calm everyone down.

I have run across some fantastic provider over my years, but this issue always seems to set off someone at every office I have encountered. Aside from being unprofessional I have yet to run across a solid explanation for their objections.

rox123

I don’t think so, I always thought obgyns had no desire to .. “go where no man has gone before” with no reason.

Inmara

That sounds awful and hopefully is not a normal practice anywhere. (TMI ahead) When I was a virgin (in my early twenties) no GYN would ever suggest to check me with speculum, SOP was to perform bimanual pelvic exam by inserting fingers in rectum. Actually, the idea that virgins can even use tampons still baffles me; in my case there was no way I could have inserted something there without damaging hymen.

momofone

I think that sounds reasonable. I’m so sorry you had such an experience. As I stated earlier, I’m not qualified to address the medical part of that question. In my work, though, I’ve worked with many people who believed they were in mutually monogamous relationships and been shocked to find that they had a sexually transmitted disease because their partner was not monogamous.

Dr Kitty

HPV can be transmitted by any kind of sexual contact, not just PIV intercourse.

So gay women still need smears, and people who are “technically” virgins but who have done “everything but” and their partners need smears. As do adult survivors of child sexual abuse or rape.

Some people will not disclose histories of child sexual abuse, non consensual sexual activity or teenage same sex experimentation to their partners.

If you can say, with certainty, that you have never engaged in any kind of sexual activity, at any age, with any person- then yes, your risk of HPV is so low that a smear is not a useful test (no test is 100%, and positive and negative predictive factors come into play).

Sometimes people may think they are at a lower risk than they really are e.g. the people who do “everything but”, gay women.

I generally spell it out that anyone who has ever had another person, of any gender, at any age who wasn’t wearing surgical gloves or changing her nappy, in contact with her genitals should have a smear.

And it is always “should have” not “must have”.

The only physical examination I insist on for contraception is blood pressure.

Adelaide

Thank you.

Mariana

What is the incidence of cervical cancer on women that do not have HPV?

Dr Kitty

More than 99% (most sources will say “virtually all”) cervical cancer is caused by HPV.

The remaining tiny minority is almost always in women with other risk factors and exposure to other carcinogenic factors (such as a smoker with HIV).

Googling “non HPV cervical cancer” is not something I would recommend. It leads to a rabbit hole of anti-vax sites. One of the top hits is Health Impact News citing a paper in Mollecular Cytogenetics to back their assertion that Gardasil is useless.

I read the Mollecular Cytogenetics paper.
Would it surprise you to know that the authors say nothing of the sort?

Mariana

Interesting! And very reassuring! I don’t have HPV (I’ve only had one partner ever, and he hadn’t been with anyone by me) and I have always tested negative for HPV (I get tested every year, with a pap, which is the norm here). A year ago I had an altered pap, but it came back inconclusive (the lab didn’t say what was wrong). I got tested again and it came back normal. But now my doctor wants to keep testing me every 6 months… I was worried… But I guess she is just being very cautious. (And I still test negative for HPV in every test).

Nick Sanders

No, it wouldn’t surprise me. If Natural News ever properly cites a paper that both back their claims and is credible, that’s what will surprise me.

webhill

The USPSTF document states “For the purposes of this recommendation, the term “pelvic examination” includes any of the following components, alone or in combination: assessment of the external genitalia, internal speculum examination, bimanual palpation, and rectovaginal examination.” So, I am a little confused by your statement that their recommendation only applies to the bimanual exam, not the speculum exam. Can you offer some clarification?

guest

It doesn’t say anything about cervical scraping for a PAP smear. You do need a speculum to do that, but other exams may also be called “speculum examination.”

Lisa

The reason there is so much happiness about this is that many gynecologists held birth control pills hostage to the annual exam. The two should never have been connected. There is no male medication that a man can’t get if he refuses an unrelated test or procedure.

Every gynecologist who refused birth control pills to women who didn’t want the pap smear should be ashamed of himself/herself.

guest

That actually had a lot to do with why I stopped taking the pill. Iiked my OB-GYN just fine, but her office kept me waiting for hours sometimes, just for an annual exam. Once upon a time, my GP performed the annual exam as part of my well-visits. Since I have asthma, I’m supposed to see my GP regularly so she can check up on that. It really annoyed me when I had to start seeing two doctors for routine care that one used to cover, and one of those doctors was always seriously behind schedule. So I just quit going for annuals and therefore stopped the pill as well.

Liz Leyden

I was under the impression that prescriptions are only valid for 1 year, regardless.

Lisa

They are, but doctors would refuse to renew the birth control prescription unless the woman submitted to a pap smear. University medical centers were particularly obnoxious about it.

CandiO

They are only valid for one year, and no I won’t just refill it for another year without seeing the person in my office and at least getting vital signs and discussing symptoms/issues/concerns.

Charybdis

They aren’t talking about stopping the Pap smear. That still gets done annually, or, depending on your case every 3-5 years.

Abby

This is pretty behind the times practice in the uk, in fact if you tried to insist on a yearly ‘pelvic exam’ as part of a pill check you would get struck off the medical register I think! The safety things with a pill check are blood pressure, migraines etc and our ‘bible’ of contraception, Guillebaud specifically says pelvic and breast examination is not indicated. A cervical smear is only indicated every 3-5 years and is a voluntary screening programme that it is perfectly acceptable to opt out of – informed consent and all that… I agree it misogynistic practice, basically making it difficult and unpleasant to get contraception for women

Who?

In Oz I have both every time, which is every two years I think. Breast check at the same time. I had a dermoid cyst removed along with the ovary it had overwhelmed about 10 years ago, so maybe checking the remaining one-which I think is on its last legs-is part of the deal?

Dr Kitty

So the ACOG is basically advising what has been SOP in Europe for decades?

If I think about it, I haven’t had a bimanual exam for a while, too (I have pap smear once a year when I visit my GYN; there is a government program for screening which invites women and pays for it every 3 (or 5? can’t remember exactly) years. When I had some complaints about pain and increased discharge, we went straight to the transvaginal ultrasound.

lawyer jane

Ovarian cancer scares me. I understand that there’s no good population-based evidence for the bimanual exams, but I’d still feel better if I got one! In part because if the follow up is just an ultrasound, that doesn’t seem too terribly invasive. Or does this sometimes result in a biopsy too?

AnnaPDE

Yeah, every time I read “unneeded ultrasound” I wonder what harm there is in actually taking a look.

guest

Harm to someone’s wallet, maybe? Personally, I like ultrasounds, particularly the non-transvaginal kind. It’s like they wave a magic wand over you.

The Computer Ate My Nym

TMI, but small personal anecdote: At one point I was considering an IUD. Because I have had a c-section, the gynecologist wanted an ultrasound before putting one in, to check the uterine scar. The scar, apparently, is now okay, but the U/S also showed an ovarian cyst that looked possibly suspicious. The recommendation was a follow up exam in 2 months because in a pre-menopausal woman these often go away. The short is that it did go away, but I spent 2 months worried that I had an ovarian cancer. So, a risk of causing increased anxiety. Also, the ultrasound is trans-vaginal so not the most comfortable thing in the world and very small risk of trauma from the exam. Not terribly high risks, but not zero either.

Dr Kitty

VOMIT
Victim of medical imaging technology.
Let’s say you have a scan that shows something, an incidental finding, which may or may not mean something.
For example a small cyst or a lymph node.
No symptoms from it, but now it has been seen it needs further follow up.
Maybe you have a CT scan. The lesion is still there and the diagnosis is no clearer.

You have a biopsy of the node or surgery to drain the cyst.
The biopsy is negative, the fluid from the cyst is benign- confirming that no action needed taken.
But you suffer a complication such as infection or bleeding, requiring costly and time consuming treatment.

CT scans are equivalent to hundreds of X-rays.
If you have annual CT scans, your chances of developing cancer is not insignificantly raised.

Sometimes imaging shows up findings (like some aneurysms) which may have a serious impact on your ability to get life insurance but the risks of prophylactic treatment can be so high that most surgeons advise against it. So now you’ve got a sword hanging over your head and a lifetime of worry.

There definitely can be harm done, not always just stress and anxiety, from over investigating.

CSN0116

OT: Pinworm. Mother of God.

My daughter woke up two nights ago complaining that her “butt itched.” We gave her some cream and ignored her — it was just a get out of bed tactic, right? Wrong. Same thing happens last night and my mind immediately goes to pinworm :-O After taking a stool sample and **applying a strip of packing tape to my daughter anus this morning for analysis** I WAS RIGHT. Hands down the grossest thing I’ve dealt with in 7 years of motherhood. She’s a nail biter/mouth toucher, despite constant reprimand to stop, so this was really just a matter of time.

Oh, and I just had to get SEVEN doses of Albenza, which, if you didn’t know, is not available in generic in the US because when its rights were bought some years ago, the new owner jacked the price up to high heaven. Just cuz. Everywhere else in the world Albenza = $0.06 per dose. In the US Albenza = $25-$50 per dose.

I shelled out $175 to contain and prohibit the infestation. Puke!

Mattie

god! Got any friends in the UK who could send you a couple of boxes for cheap?

Burgundy

Or Canada?

CSN0116

I live minutes from the Canadian border. I wish I wasn’t so freaked out that I jumped to just purchasing here in the US. The drug starts to work very quickly and I didn’t want her tormented another night, so I just up and paid for it 🙁 If we need to refill in three weeks (unlikely), I’ll refill in Canada; that’s a great idea, thanks!

Burgundy

I totally understand you pain. The drug price in US are so ridiculous, I stock up medicine every time I go back to Asia for a visit.

Dr Kitty

Albenza is Albendazole, right?
Mebendazole (Vermox/Enverm) is cheaper and you can buy it OTC in Canada.

In the UK you can even get treatment free on the minor ailments scheme. LOVE the minor ailments scheme- people get free stuff from a pharmacy for minor issues instead of seeing a Doctor unnecessarily just because they don’t want to pay for things they know they can get free on prescription. We have opposite issues to the USA sometimes.

Yes! But Mebendazole isn’t available in the US anymore, thus no more generic option. My dr tried to write a script for it; three pharmacists confirmed Albenza is all that’s available. Evil bastard pharm company. And minor ailments scheme?! As an American I cannot even fathom something so logical.

Who?

Ick hate parasites. That is a horrible amount of money. My mother used to dose us up with ‘worm medicine’ periodically. It was foul.

CSN0116

Does it work? Get the recipe from her and give it to me 😉

Who?

Well I’ve never had worms. It was some random thing from the chemist in the sixties/seventies, it’s probably banned now!!

I’m a shocker for mouth and face touching, and a nut for hand hygiene. How old is she? If she’s got to seven before getting them hopefully this is your one and only bout.

My middle kiddo caught them a while back, I need to do a check to see if she’s picked them up again thanks to her saying exactly the same thing last night. Ugh!
When I worked at the vet surgery, we used to suggest to parents to worm their kids whenever they worm their pets, just to be safe. It’s certainly a tempting idea!

guest

You know, I’m a mouth toucher/nail biter and always have been but I have never had pinworms.

CSN0116

God bless you, you don’t want this 🙁 kids who suck their thumbs/bite nails are more prone, apparently. Who knew? All those times I told her “you’ll get sick doing that!” – and she hardly ever does because she’s just a hardy kid, I should have been scaring her by threatening pinworms! LOL

guest

Oh no, I know all about it and I don’t want it. I just meant that I’m not sure it’s inevitable if you have that habit. Maybe focus on good handwashing/wiping habits if she can’t break the oral fixation.

My daughter got such a bad one when she was 4 that her thumb nail fell off (it grew back). My son is teething and spends all his time with his fingers in his mouth. He had a paronychia last week, thankfully I was able to get it sorted before it got too bad!

A few Google images of paronychia might also have scared her off!

CSN0116

Mother fucker…

These damn kids are gonna be the death of me.

Charybdis

Me too. I guess I got lucky (so far…).

Linden

Aaah, I’d never even heard of pinworms!

Guest

They are more annoying than anything but they can certainly affect sleep. :/

Lisa Cybergirl

Do you live in Florida (or other Southern location)? I remember reading they were “endemic” there. Sure seemed like it when I was a kid – despite my every effort, they kept coming back. At one point my Dad said if I got them one more time, he would give me dog worm medicine from the grocery store – I believed him, and so never told anyone I had them again. They eventually died out!

CSN0116

No, we’re in NY. And I feel bad for the little girl you 🙁 I hadn’t thought of the possibility of them coming back. I’m just so happy to be rid of them… for now :/

Guest

For future reference, there is an effective and much cheaper OTC to treat pinworms. Each bottle contains 2-6 doses depending on the person’s weight. The two brands are Pin X and Reese’s pinworm medicine. You do two doses two weeks apart along with washing sheets, clothes, and towels. My daughter has had them a few times and this has fixed her up.

Drat. I was always a patient who was willing to let the family medicine interns at my PCP’s office practice bimanual exams on me since it was good training for them and a whopping 1 minute of my life for a good cause.

Of course, half the time I forgot to tell them that I am very, very, very ticklish in the perfect position for the left side bimanual exam and would startle them when my booming, snorting laugh started.

CanDoc

As a gynaecologist, I have never seen a patient in consultation because of findings from a bimanual exam. Only if the follow-up ultrasound (or symptoms that precipitated the exam) requires my expertise.
However, it was a routine bimanual exam (by a GP) that discovered my mother’s own 22 cm borderline ovarian tumour – so I’m in the bizarre position of agreeing that screening bimanual exams don’t have adequate evidence to support them on a population level, but concurrently recognizing that my own mother benefitted from just such an exam.

Karen in SC

22 cm? Were there any symptoms?

CanDoc

Amazingly, none that she noticed. Although after it was out she was happy to lose her “age-related bulge”. 😉

Squillo

And if gynecologists do not bill for a pelvic exam and the follow-up it often triggers, their incomes would decline.

I don’t think there is even a CPT code for a screening bi-manual pelvic exam. So how could including one (necessary or not) be a money-making strategy?

Madtowngirl

I don’t care if it’s a money making plot or not, I know too many women who have caught early cancer because of a PAP. Im getting mine every time I need to.

Speaking of that, my doctor doesn’t recommend another one for me for 5 years. Granted, I’m in my early 30s, had the same partner for years, and I’ve never had an abnormal PAP, but my mother and sister have. Does that seem too long to wait to anyone else?

Violet EMT

My doc explained to me that women over 30 in monogomous relationships who have no gyn symptoms and have never had an abnormal pap/HPV test can go every 5 years, especially if they’ve had the HPV vaccine. She also told me to tell her if my monogomy status ever changes, or if I ever have symptoms. That’s the new American Cancer Society recommendation.

I am all of those things (age 29, monogamous relationship, no GYN symptoms, never had an abnormal pap or HPV test, and I received the HPV vaccine at ~age 19) — but I still receive a PAP and bimanual exam annually. (The bimanual is less than 10 seconds of my time.) My GYN also always does a breast exam at this time. All of this takes like 7 minutes.

Some of us have a much more difficult time with the pap smear. I’ve only ever been able to have a pap smear under general anesthesia.

I have a very easy, pain-free period every month, but that doesn’t mean I get to dismiss the problems of women who have a more difficult period. Just because the pap smear is quick and easy for you doesn’t mean the rest of us should endure it annually.

guest

I don’t think she was saying everyone should undergo it every year, just that she would be anxious going that long without one, so maybe it would be best for her to be able to opt in to a yearly PAP.

CSN0116

Ding ding ding.

Never implied an ounce of what pp stated. I’m confused as all hell…

guest

Saying “opt in” was pretty clear to me.

guest

Huh. I’m still being told every three years, but perhaps it’s because I’m in no relationship at all and they think that could change anytime? (It won’t, and in any case they could tell me “every five years unless you become sexually active again.”)

corblimeybot

I’ve been monogamous with the same person (my spouse) for over 7 years, and I get paps every three years, too. I don’t know what the reasoning is, but I’m comfortable with that schedule myself.

Dr Kitty

I don’t like the monogamy caveat, simply because while YOU may be monogamous, your partner may not be, and not everyone is open and honest about it, and HPV is so ubiquitous.

I’ve seen too many STIs in “happily married” people.

The U.K. screens every 3years from 25-50, every 5 years from 50-64.
HPV testing on every abnormal or borderline sample, and a period of more frequent screening if previous abnormalities or LLETZ.
Cervical smears encouraged for any woman who has ever had any kind of sexual activity with a partner of any gender.

CanDoc

See the article: A routine Pap test is STILL recommended. It’s a routine bimanual (the internal exam using the examiner’s fingers) that doesn’t have sufficient evidence for a recommendation.
Depending on the Pap history and whether routine HPV testing is used, low-risk women can often be streamed into pap screening intervals from every 2 to every 5 years, depending on what local screening programmes have decided. In our area, a normal pap yearly for three years means low-risk women can space out to every 3 years. Another area in Canada uses HPV testing, and a negative test means no retest for 5 years.

Madtowngirl

Thanks. I didn’t see that on my first read through. I’ve got antibiotic brain.

MI Dawn

Here. Have some all natural herbs that I picked from a field. I have no idea what they are, but since they are all natural, they can’t be dangerous, right? Much better than antibiotic brain. 🙂

Bombshellrisa

You saw a horse or goat eat them first, right? That proves that they are good. Hey, it’s how that Hoxsey cancer cure was found.

MI Dawn

Nah. Just picked them because they were pretty. Nothing pretty can be dangerous.

Who?

Exactly. And you just need to trust your judgment and not be clouded by negativity while gathering them. Because attitude is so important.

You know, I might have believed that until I watched one of our cows eat a thistle plant. On a fresh pasture. While there was a full hayring and concentrated feed nearby. (Although, they do need pokey things to keep their rumen healthy; an entire thistle plant, though, feels like overkill.)

momofone

Are you crazy? Don’t you know Monsanto has probably contaminated all the fields?! The toxins!!!!

MI Dawn

Oooops! Well, I live in New Jersey. I think the Monsanto toxins are less dangerous than the exhaust fumes from the Garden State Parkway and NJ Turnpike on a Friday evening!

(Yes, it’s summer and all the weekend daytrippers are clogging up the main roads. I go nowhere on the weekends if I can’t use local roads.)

(I cut out a huge chunk of wall in one of my bathrooms yesterday…we’d thought the walls in that room were plaster, but turns out it’s stucco over sheetrock, which was a technique that was used for a short time decades ago, and is annoying. Anyway, even though I had a fan directing dust outside and a good mask, I still inhaled enough dust to coat my nose, which is annoying).

Megan

In the US, current recommendations are co-testing (pap and high risk HPV testing) every 5 years or pap alone every 3 years for women once they reach their 30’s. I am happily on the 5 year plan too. Obviously those recommendations change if any of your testing is abnormal.

Amy Tuteur, MD

Dr. Amy Tuteur is an obstetrician gynecologist. She received her undergraduate degree from Harvard College in 1979 and her medical degree from Boston University School of Medicine in 1984. Dr. Tuteur is a former clinical instructor at Harvard Medical School. She left the practice of medicine to raise her four children. Her book, Push Back: Guilt in the Age of Natural Parenting (HarperCollins) was published in 2016. She can be reached at DrAmy5 at aol dot com...
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